Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493008981
Report Date: 03/14/2018
Date Signed: 03/14/2018 11:04:56 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:LITTLE OAKS MONTESSORI PRESCHOOL AND KINDERGARTENFACILITY NUMBER:
493008981
ADMINISTRATOR:STILL, CHERYLFACILITY TYPE:
850
ADDRESS:715 PETALUMA BLVDTELEPHONE:
(707) 763-5962
CITY:PETALUMASTATE: CAZIP CODE:
94952
CAPACITY:30CENSUS: 12DATE:
03/14/2018
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cheryl StillTIME COMPLETED:
11:10 AM
NARRATIVE
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An inspection was conducted at the facility by LPA Patricia Pacheco. The facility file was reviewed prior to this inspection. A review of the personnel report on file indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. This is a center with a separate infant licensee with a toddler option. Children of different age groups have separate activity areas.

Operating hours are 7:30 am - 6:00 pm, Monday-Friday. The facility was toured inside and outside and the floor and yard plan were verified. The items which could pose a danger to children (detergents, cleaning compounds and medications) were inaccessible to children. The licensee stated that there are no poisons in the facility and none were observed during today's inspection. The facility was free of flies, insects and rodents. The toys, floors, desks and other equipment and surfaces appeared clean, toxic free, safe and in good condition. There is uncontaminated drinking water available to children both indoors and outdoors. The children’s bathrooms appeared in safe and sanitary condition. Meals and snacks are brought from children's home. Food is properly stored and free of contamination. The playground was free of hazards. The playground equipment and surface areas appeared in safe condition. There is recycled rubber cushioning underneath climbing structures and/or play equipment sufficient to absorb falls. There were no bodies of water observed. The licensee stated no weapons are stored on site and none were observed. During today's inspection, staffing ratios were being met and children were being properly supervised. The facility was operating within the licensed capacity. At least one staff member present possessed current CPR and First Aid certifications. Children’s records were reviewed and contained identification forms with authorized representative information, as well as medical assessments. Staff records were reviewed and contained health screening forms. The sign in/out procedure was reviewed and in compliance. This facility is providing Incidental Medical
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 513-1214
LICENSING EVALUATOR NAME: Patricia PachecoTELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2018
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: LITTLE OAKS MONTESSORI PRESCHOOL AND KINDERGARTEN
FACILITY NUMBER: 493008981
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/14/2018
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/13/2018
Section Cited
CCR
1596.7995
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Staff Immunizations. Commencing September 1, 2016, a person shall not be employed or volunteer at a day care center if he or she has not been immunized against influenza, pertussis, and measles. Staff 1 and 2 did not have evidence of required immunization in file. This presents a potential health and safety risk for children in care.
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The licensee agreed to obtain and submit evidence of immunity agaisnt measles and pertussis for Staff 1 and 2. A medical exemption signed by a physician may also suffice. Evidence shall be sent to CCLD by 04/13/18.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 513-1214
LICENSING EVALUATOR NAME: Patricia PachecoTELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2018
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2018
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME: LITTLE OAKS MONTESSORI PRESCHOOL AND KINDERGARTEN
FACILITY NUMBER: 493008981
VISIT DATE: 03/14/2018
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Services – IMS. Incidental Medical Services (IMS) policy was discussed. LPA reviewed storage of medication and equipment/supplies, and reviewed children’s, personnel, and administrative records. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Child Care Centers Sections 101173 and 101226.The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: www.ada.gov/childqanda.htm. This report was reviewed and discussed with the licensee. All licensing reports are public information and must be made available upon request for at least three years.

Notice of Site Visit shall be posted for 30 days from today's visit.

The following violation of the California Code of Regulations, Title 22; Division 12, were observed: see LIC 809D. Appeal Rights were provided.
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 513-1214
LICENSING EVALUATOR NAME: Patricia PachecoTELEPHONE: 530-895-5886
LICENSING EVALUATOR SIGNATURE:

DATE: 03/14/2018
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2018
LIC809 (FAS) - (06/04)
Page: 3 of 3